Provider Demographics
NPI:1588874093
Name:BAE, MYUNG E (DOM)
Entity type:Individual
Prefix:DR
First Name:MYUNG
Middle Name:E
Last Name:BAE
Suffix:
Gender:
Credentials:DOM
Other - Prefix:DR
Other - First Name:MYUNG
Other - Middle Name:E
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:36-09 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6502
Mailing Address - Country:US
Mailing Address - Phone:718-461-0338
Mailing Address - Fax:718-358-9722
Practice Address - Street 1:36-09 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6502
Practice Address - Country:US
Practice Address - Phone:718-461-0338
Practice Address - Fax:718-358-9722
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27171100000X
NY48171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY798257OtherOXFORD
NY90X631OtherEMPIRE BLUE CZ SHIELD